P1368: OUTPATIENT AUTOTRANSPLANTS FOR PERSONS WITH MULTIPLE MYELOMA
Authors: J. M. Sánchez-Raga, M. Jiménez, L. García-Maño, N. Beltran, T. Ros, C. Martorell, J. Ginés, M. Batle, L. Casado, S. A. Jiménez, S. Pérez-León, E. Medina, J. O. Díaz-Carbonero, A. Pérez-Montaña, L. Bento, A. Sampol-Mayol
Journal: HemaSphere (2022)

Background: Patients younger than 70 years diagnosed with multiple myeloma (MM) and without associated comorbidities routinely receive consolidation treatment with hematopoietic Stem Cell Transplantation (SCT) conditioned with high-dose melphalan after several induction cycles. In the last two decades, numerous experiences have been published from different countries of results obtained through home and outpatient transplants. The difference between the two is that in the first model, the nurse usually goes to the patient’s home on a daily basis to administer medication, health care, and take blood tests, and in the second model, the patient goes to the hospital on certain days to receive this care and medical visits. Aims: We report the results of the first patients included since we started the program in 2019. Methods: We reviewed the electronic medical records in the computer system of our center (Millennium) of all patients with MM who have received an autologous SCT in our center from January 2019 to 2022, accounting for all those who have been specifically assessed for the outpatient program and we collect in an Excel the reasons for exclusion from the program, day of recovery of neutrophils (>500 neutrophils/uL) and platelets (>20,000/uL), number of face-to-face visits, readmissions, mucositis G III and IV, fever, as well as microbiological isolates obtained in an excel. Results: Since the implementation of the outpatient SCT program in our center in January 2019, 57 autologous SCT have been performed on patients with Multiple Myeloma. 23 of them have not been candidates due to interruption of the program due to the pandemic situation (34 remain). Of these 17 (50%) were assessed in the pre-HSCT consultation: 2 patients rejected due to comorbidities (1 with a history of complications due to multiresistant bacteria), 4 patients preferred the hospitalized model, 3 patients could not due to the absence of a caregiver and finally 10 agreed to perform the ambulatory HPT, and 9 were finally able to perform it. 8 were male. Median age was 50 years (range 41-64). 8 were in the first line of treatment (induction with bortezomib-lenalidomide-dexamethasone scheme). Median neutrophil recovery was 11 days and median platelet recovery was 13 days. 1 patient was readmitted on day 5 due to mucositis and oral intolerance and remained hospitalized until discharge. 4 patients presented fever on day 9 and were admitted a median of one day for this reason. No microorganisms were isolated in the microbiological studies and it was suspected that it could be a seizure syndrome. The median outpatient follow-up of 12 days and the median number of Day Hospital visits was 5. The transplant-related mortality in the outpatient cohort was 0%. Summary/Conclusion: Outpatient transplantation is a safe procedure with efficacy and safety results similar to hospitalization with a significant decrease in the costs of the procedure associated with admission. The selection of the patient and caregiver is fundamental, since not all patients will be candidates for the same for health, social reasons and/ or their preference. The most frequent reason for readmission is fever, and they can be discharged with empirical intravenous antibiotic treatment in the first 24 hours in most cases. With our results, supported by the experience of other centers, we are considering the cancellation of the prophylactic administration of G-CSF to reduce the incidence of engrafment syndrome.